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Abstract

To the editor: Fisher's letter in the December issue (Ann Intern Med 87:792, 1977) on tuberculosis after gastrointestinal surgery contains some misinformation about tuberculosis and its pathogenesis and demonstrates some of the problems noted by Byrd (1) that emerge as tuberculosis re-enters the mainstream of medicine from its relative isolation in sanitoria.

That contact with an active case of tuberculosis could not be established in Fisher's 57-year-old diabetic patient who had a positive reaction (12 mm) to PPD preoperatively is not surprising. For uncertain reasons the patient reactivated his initial (old) tuberculous infection manifested by the positive PPD in the